Washington Highlights: April 25,
2008
House Passes Medicaid Legislation, Administration's
Advisors Threaten to Veto
Contents
Prior Issues
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The House of Representatives April 23 passed (349-62)
the AAMC-supported "Protecting the Medicaid Safety Net Act
of 2008" (H.R.
5613). The legislation delays until April 1, 2009, implementation
of the Medicaid proposed rule affecting graduate medical education
(GME) payments and the Medicaid final rule regarding cost limits/units
of government (the "IGT Rule"). Republican members accounted
for 128 of the 349 votes in support of H.R. 5613.
According to a Statement
of Administration Policy (SAP) issued April 22, the President's
"senior advisors" would recommend a veto of H.R. 5613
"in its present form." The SAP explains that H.R. 5613
would "prevent the Administration from responsibly clarifying
ambiguities in current Medicaid regulations and from stopping blatant
abuses of the Federal-State partnership" under Medicaid. It
adds that "Blocking the CMS regulations ignores the policy
recommendations and investigatory findings of the [Government Accountability
Office] and the [Office of the Inspector General] and will put billions
of dollars of Federal funds at risk."
The Senate has not yet taken up legislation that addresses the
Medicaid rules.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
House Reauthorizes SBIR/STTR Programs, Retains
Funding Percentages at Current Rates
The House passed legislation April 23 to reauthorize the Small
Business Innovation Research (SBIR) and the Small Business Technology
Transfer Research (STTR) programs after agreeing to retain at their
current levels the percentages of federal science agency budgets
used to fund these programs.
The House passed (368-43)
the "SBIR/STTR Reauthorization Act" (H.R.
5819). As reported out of the House Small Business Committee
on April 18, the bill would have increased the SBIR set-aside from
2.5 percent to 3.0 percent and the STTR set-aside from 0.3 percent
to 0.6 percent of any federal agency that spends more than $100
million in research per year. A similar increase had been proposed
in the "Science and Technology Act of 2008" (H.R.
5789), which the House Science and Technology Subcommittee on
Technology and Innovation approved April 16 [see Washington
Highlights, April 18].
The House adopted by voice vote an amendment by Rep. Vernon Ehlers
(R-Mich.) to retain the SBIR and STTR set-asides at their current
levels. Rep. Ehlers noted, "If we increase the SBIR and STTR
program percentages while other agency's funding remains flat, we
begin to severely erode our fundamental research base. I would much
rather see us fight over extra funding for our basic research programs,
our fundamental research programs, of which a percentage would then
transfer into SBIR and STTR."
The House agreed to the amendment after House Small Business Committee
Chair Nydia Velaquez (D-N.Y.) announced that she would accept the
amendment and pledged to work with Rep. Ehlers "to increase
the amount of Federal research dollars available to small firms
without raising concerns about the country's critical research priorities."
AAMC President and CEO Darrell G. Kirch, M.D., endorsed the Ehlers
amendment in an April 22 letter
that stated, "While the AAMC supports the objectives of the
SBIR and STTR programs, it is essential that increases for these
programs not come at the expense of the funding for the science
agencies' other core programs." The amendment also was supported
by the Association of American Universities, the Federation of American
Societies for Experimental Biology, and the National Association
of State Universities and Land Grant Colleges.
House Appropriations Chair David Obey (D-Wis.) also supported the
amendment in a strong statement presented earlier in the day on
the House floor on the impact that increasing the SBIR/STTR set-asides
would have on NIH in the current budget climate. Noting the bill
would result in $187 million less being available for traditional
medical research grants, Chairman Obey stated, "The fact is
that the success rate for small business grants under this bill
is expected to rise to 52 percent whereas the success rate for applications
for traditional NIH grants is expected to decline to 18 percent.
That is a disparity that the scientific community and the country
at large simply cannot afford."
In a Statement
of Administration Policy (SAP) issued April 22, the White House
strongly opposed the increases in the set-asides, noting they "would
effectively cut $650 million each year from the core, competitive
research activities of the Department of Defense, the National Institutes
of Health, NASA, the Department of Energy, the National Science
Foundation, and other agencies."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC Comments on NCRR Draft Strategic Plan for
FY 2009-2013
The AAMC April 23 submitted follow-up comments to the National
Institutes of Health (NIH) National Center for Research Resources'
(NCRR) draft Strategic Plan for FY 2009-2013. The AAMC commends
the center for its leadership in NIH's effort to re-engineer the
clinical research enterprise and its support of innovative approaches
and emerging partnerships and collaborations. While fully endorsing
the NCRR strategic plan, the AAMC restates two points of concern
that were originally expressed in the Association's Sept. 10, 2007,
comment letter,
but which are not addressed in the current NCRR draft.
The AAMC encourages NCRR's commitment to provide resources both
for community based research and for addressing the so-called "knowledge
translation block," that is, to facilitate the implementation
of successful discoveries and practices into clinical and preventive
care. The Association expresses concern about the signal sent by
the lack of an itemized strategy and specific action items in the
draft strategic plan to address this "block."
The second point indicates the strategic plan should reassure the
scientific community that services currently provided to clinical
and translational researchers by General Clinical Research Centers
(GCRCs) would be preserved and enhanced within the CTSA program.
The AAMC believes the plan should include a commitment to optimizing
the transition from the existing array of GCRC structures (e.g.,
Pediatric, Outpatient, and Inpatient) into CTSA's Clinical Research
Units (CRU) as well as outline options for GCRCs that, for variety
of reasons, will fail to fold into CTSA awards.
Information:
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Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
Rehab Facilities Receive a Zero Percent Update
under FY 2009 Proposed Rule
The Centers for Medicare and Medicaid Services (CMS) April 21 released
its Medicare inpatient rehabilitation facility (IRF) proposed
rule for federal fiscal year (FY) 2009. The proposed rule would
apply a zero percent increase factor to IRF payment rates for FY
2009. If finalized, the policies will be effective Oct 1, 2008.
Comments on the proposed rule are due June 20.
Total IRF payments for FY 2009 are estimated to decrease by approximately
$20 million. This decrease is due to the CMS-proposed increase in
the outlier threshold, which will decrease total outlier payments
from 3.3 percent of total estimated payments in FY 2008 to 3.0 percent
in FY 2009.
Effective July 1, 2006, a facility qualifies as an IRF --and for
higher PPS payments than inpatient hospitals-- if 60 percent of
its patient population has one of 13 specified qualifying conditions.
The proposed rule makes permanent this 60 percent threshold in accordance
with the "Medicare, Medicaid and SCHIP Extension Act"
(MMSEA, P.L. 110-173). Historically this threshold had been set
at 75 percent and was scheduled to return to that level July 1,
2008.
The proposed rule also implements a provision of the MMSEA that
allows facilities to count patients who do not meet inpatient rehabilitation
services for one of the 13 specified conditions, but whose treatment
is complicated by the presence of one of those conditions as a secondary
diagnosis. This policy was previously scheduled to expire July 1,
2008.
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
ED Issues Dear Colleague on Increased Health Professions
Loan Limit
The Department of Education (ED) April 18 issued a Dear Colleague
letter (GEN-08-04)
that raises the combined aggregate Stafford loan limit for certain
health professions students (including medical students) from $189,125
to $224,000, effective April 18, 2008. This increase is entirely
in unsubsidized Stafford loans and will allow medical students to
borrow at a 6.8 percent interest rate, avoiding higher rates under
the GradPLUS and private loans.
The increase comes in response to a Sept. 4, 2007, AAMC-coordinated
sign-on letter to Secretary of Education Margaret Spellings [see
Washington Highlights,
Sept. 7, 2007]. The Secretary originally announced the Department's
decision in a Feb. 28 letter to AAMC President and CEO Darrel G.
Kirch, M.D.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
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